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Title: Prospective Study Delivering Simultaneous Integrated High-dose Tumor Boost (≤70 Gy) With Image Guided Adaptive Radiation Therapy for Radical Treatment of Localized Muscle-Invasive Bladder Cancer

Abstract

Purpose: Image guided adaptive radiation therapy offers individualized solutions to improve target coverage and reduce normal tissue irradiation, allowing the opportunity to increase the radiation tumor dose and spare normal bladder tissue. Methods and Materials: A library of 3 intensity modulated radiation therapy plans were created (small, medium, and large) from planning computed tomography (CT) scans performed at 30 and 60 minutes; treating the whole bladder to 52 Gy and the tumor to 70 Gy in 32 fractions. A “plan of the day” approach was used for treatment delivery. A post-treatment cone beam CT (CBCT) scan was acquired weekly to assess intrafraction filling and coverage. Results: A total of 18 patients completed treatment to 70 Gy. The plan and treatment for 1 patient was to 68 Gy. Also, 1 patient's plan was to 70 Gy but the patient was treated to a total dose of 65.6 Gy because dose-limiting toxicity occurred before dose escalation. A total of 734 CBCT scans were evaluated. Small, medium, and large plans were used in 36%, 48%, and 16% of cases, respectively. The mean ± standard deviation rate of intrafraction filling at the start of treatment (ie, week 1) was 4.0 ± 4.8 mL/min (range 0.1-19.4) and at end of radiation therapy (ie, week 5 or 6)more » was 1.1 ± 1.6 mL/min (range 0.01-7.5; P=.002). The mean D{sub 98} (dose received by 98% volume) of the tumor boost and bladder as assessed on the post-treatment CBCT scan was 97.07% ± 2.10% (range 89.0%-104%) and 99.97% ± 2.62% (range 96.4%-112.0%). At a median follow-up period of 19 months (range 4-33), no muscle-invasive recurrences had developed. Two patients experienced late toxicity (both grade 3 cystitis) at 5.3 months (now resolved) and 18 months after radiation therapy. Conclusions: Image guided adaptive radiation therapy using intensity modulated radiation therapy to deliver a simultaneous integrated tumor boost to 70 Gy is feasible, with acceptable toxicity, and will be evaluated in a randomized trial.« less

Authors:
 [1];  [2]; ; ; ; ;  [1]; ; ; ; ; ; ;  [2]; ; ;  [1]
  1. The Institute of Cancer Research, London (United Kingdom)
  2. The Royal Marsden National Health Service Foundation Trust, London (United Kingdom)
Publication Date:
OSTI Identifier:
22645143
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 94; Journal Issue: 5; Other Information: Copyright (c) 2016 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BLADDER; COMPUTERIZED TOMOGRAPHY; GY RANGE 10-100; IMAGES; NEOPLASMS; PATIENTS; RADIATION DOSES; RADIOTHERAPY; TOXICITY

Citation Formats

Hafeez, Shaista, The Royal Marsden National Health Service Foundation Trust, London, Warren-Oseni, Karole, McNair, Helen A., Hansen, Vibeke N., Jones, Kelly, Tan, Melissa, Khan, Attia, The Royal Marsden National Health Service Foundation Trust, London, Harris, Victoria, McDonald, Fiona, Lalondrelle, Susan, Mohammed, Kabir, Thomas, Karen, Thompson, Alan, Kumar, Pardeep, Dearnaley, David, Horwich, Alan, Huddart, Robert, and The Royal Marsden National Health Service Foundation Trust, London. Prospective Study Delivering Simultaneous Integrated High-dose Tumor Boost (≤70 Gy) With Image Guided Adaptive Radiation Therapy for Radical Treatment of Localized Muscle-Invasive Bladder Cancer. United States: N. p., 2016. Web. doi:10.1016/J.IJROBP.2015.12.379.
Hafeez, Shaista, The Royal Marsden National Health Service Foundation Trust, London, Warren-Oseni, Karole, McNair, Helen A., Hansen, Vibeke N., Jones, Kelly, Tan, Melissa, Khan, Attia, The Royal Marsden National Health Service Foundation Trust, London, Harris, Victoria, McDonald, Fiona, Lalondrelle, Susan, Mohammed, Kabir, Thomas, Karen, Thompson, Alan, Kumar, Pardeep, Dearnaley, David, Horwich, Alan, Huddart, Robert, & The Royal Marsden National Health Service Foundation Trust, London. Prospective Study Delivering Simultaneous Integrated High-dose Tumor Boost (≤70 Gy) With Image Guided Adaptive Radiation Therapy for Radical Treatment of Localized Muscle-Invasive Bladder Cancer. United States. https://doi.org/10.1016/J.IJROBP.2015.12.379
Hafeez, Shaista, The Royal Marsden National Health Service Foundation Trust, London, Warren-Oseni, Karole, McNair, Helen A., Hansen, Vibeke N., Jones, Kelly, Tan, Melissa, Khan, Attia, The Royal Marsden National Health Service Foundation Trust, London, Harris, Victoria, McDonald, Fiona, Lalondrelle, Susan, Mohammed, Kabir, Thomas, Karen, Thompson, Alan, Kumar, Pardeep, Dearnaley, David, Horwich, Alan, Huddart, Robert, and The Royal Marsden National Health Service Foundation Trust, London. 2016. "Prospective Study Delivering Simultaneous Integrated High-dose Tumor Boost (≤70 Gy) With Image Guided Adaptive Radiation Therapy for Radical Treatment of Localized Muscle-Invasive Bladder Cancer". United States. https://doi.org/10.1016/J.IJROBP.2015.12.379.
@article{osti_22645143,
title = {Prospective Study Delivering Simultaneous Integrated High-dose Tumor Boost (≤70 Gy) With Image Guided Adaptive Radiation Therapy for Radical Treatment of Localized Muscle-Invasive Bladder Cancer},
author = {Hafeez, Shaista and The Royal Marsden National Health Service Foundation Trust, London and Warren-Oseni, Karole and McNair, Helen A. and Hansen, Vibeke N. and Jones, Kelly and Tan, Melissa and Khan, Attia and The Royal Marsden National Health Service Foundation Trust, London and Harris, Victoria and McDonald, Fiona and Lalondrelle, Susan and Mohammed, Kabir and Thomas, Karen and Thompson, Alan and Kumar, Pardeep and Dearnaley, David and Horwich, Alan and Huddart, Robert and The Royal Marsden National Health Service Foundation Trust, London},
abstractNote = {Purpose: Image guided adaptive radiation therapy offers individualized solutions to improve target coverage and reduce normal tissue irradiation, allowing the opportunity to increase the radiation tumor dose and spare normal bladder tissue. Methods and Materials: A library of 3 intensity modulated radiation therapy plans were created (small, medium, and large) from planning computed tomography (CT) scans performed at 30 and 60 minutes; treating the whole bladder to 52 Gy and the tumor to 70 Gy in 32 fractions. A “plan of the day” approach was used for treatment delivery. A post-treatment cone beam CT (CBCT) scan was acquired weekly to assess intrafraction filling and coverage. Results: A total of 18 patients completed treatment to 70 Gy. The plan and treatment for 1 patient was to 68 Gy. Also, 1 patient's plan was to 70 Gy but the patient was treated to a total dose of 65.6 Gy because dose-limiting toxicity occurred before dose escalation. A total of 734 CBCT scans were evaluated. Small, medium, and large plans were used in 36%, 48%, and 16% of cases, respectively. The mean ± standard deviation rate of intrafraction filling at the start of treatment (ie, week 1) was 4.0 ± 4.8 mL/min (range 0.1-19.4) and at end of radiation therapy (ie, week 5 or 6) was 1.1 ± 1.6 mL/min (range 0.01-7.5; P=.002). The mean D{sub 98} (dose received by 98% volume) of the tumor boost and bladder as assessed on the post-treatment CBCT scan was 97.07% ± 2.10% (range 89.0%-104%) and 99.97% ± 2.62% (range 96.4%-112.0%). At a median follow-up period of 19 months (range 4-33), no muscle-invasive recurrences had developed. Two patients experienced late toxicity (both grade 3 cystitis) at 5.3 months (now resolved) and 18 months after radiation therapy. Conclusions: Image guided adaptive radiation therapy using intensity modulated radiation therapy to deliver a simultaneous integrated tumor boost to 70 Gy is feasible, with acceptable toxicity, and will be evaluated in a randomized trial.},
doi = {10.1016/J.IJROBP.2015.12.379},
url = {https://www.osti.gov/biblio/22645143}, journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 5,
volume = 94,
place = {United States},
year = {Fri Apr 01 00:00:00 EDT 2016},
month = {Fri Apr 01 00:00:00 EDT 2016}
}